Permit (43) CITY OF TIGARD PLUMBING PERMIT
`1111 ° COMMUNITY DEVELOPMENT Permit#: PLM2016-00208
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/18/2016
Parcel: 1S 136DD01000
Jurisdiction: Tigard
Site address: 6860 SW ATLANTA ST
Project: Haven Subdivision: WEST PORTLAND HEIGHTS Lot: 4
Project Description: Add washer hook-up&laundry sink
Contractor: MARK WHITED PLUMBING Owner: BOONDOGGLE LLC
10625 NW LOST PARK DR PO BOX 69506
PORTLAND, OR 97229 PORTLAND, OR 97239
PHONE: 503-351-5985 PHONE:
FAX: 503-626-9693
FEES
Quantity Description Date Amount
1 ea Clothes Washer 04/18/2016 $25.02
Specifics: 1 ea Laundry Tray 04/18/2016 $25.02
1 12%State Surcharge- 04/18/2016 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 04/18/2016 $22.46
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifi ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct estions to O C by -fling 503.232.1987 or 1.800.332.2344.
Issued y: /. Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED
City Of Tigard ,C R 1 8 2016 Received // c
Date/By: `7' /f/6 Pennit No.: ai�/6 60�<J
.111 NI 13125 SW Hall Blvd.,Tigard,OR 972 3' Plan Review C
• Phone: 503.718.2439 Fax: - Date/By: Other Permit No.:
�� 1 3
Inspection Line: 503.639.4175 t w Date Read /B orris: ® See Page 2 for
1 I t'A R l) Internet: www.ti and-or. ov 3.t.11!_.n1Kir 711\�ls t`'t`! Y Y B
g g Notified/Method: Supplemental Information
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❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
g Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
M f. _ i = t 4ts8 s,` t ,rtzs ' x 4, ' ' SFR(1)bath 1
M.I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
� �}� �y t � Fire sprinkler( sq.ft.) Page 2
_ '['� il►'E1ON .:-A--71741' Site utilities:
Job site address: �&$4 O c....) A-4-1s Catch basin or area drain 18.76
` Drywell,leach line,or trench drain 18.76
City/State/ZIP: / f e et 1) 1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
'°r Backwater valve 12.51
�S"SAI''''' '" t" p / �" " ` ''' '"" Clothes washer 1 25.02
�A el i 4x 1-�� k / T� y Sic Dishwasher 25.02
/ Drinking fountain 25.02
Ejectors/sump 25.02
' Expansion tank 12.51
Name: �L _ �� V p-_ Fixture/sewer cap 25.02
/"� Floor drain/floor sink/hub 25.02
Address: &ate 0 .L (r.-- .$ f.
Garbage disposal 25.02
City/State/ZIP: 7--, / op-- Hose bib 25.02
Phone:tc09) . 5 371-Dxt"' . • 1
ig( ) Ice maker 12.51
, kf 1, C'oNTAcD PE Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Root drain(commercial) 12.51
Address:
Sink/basin/lavatory I 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
:470,74.A4-421,1':,':''.:, fte is sau �s G r a zsra w� s Water closet 25.02
�� � ��q�a'6C ��4 E � y,;u�a :' } �* - G � ��
dP.'Iw.-, ,,,; �, . ? Itli ; .44, . _'';'1.'''''I'''''''''' '''--.4:':''''''''g''-'''''' '1-!-'0('''- Water heater 37.52
Business name: lf
/�'- (tol-A+.. 11th ` Water piping/DWV 56.29
Address: /0 to .S NL) jos f- !/04.y// r•-•l e 7x ( Other: 25.02
City/State/ZIP: . Its r , r 22-- Subtotal ems,
Phone:(cp3) 3s1 ser Fax:( ) 7//7 Minimum permit fee: $72.50 7d--J v
CCB Lic.: 3f L�S2. (%y/[7 Plumbing Lic.no.: '7/t 3-�6 Plan review (22%of permit tee) 7
1 State surcharge(12%of permit fee) �/ .....:17C-)
Authorized signature: 0,,,t......„.. (� TOTAL PERMIT FEE p7.Print name: This permit application expires if a permit is not obtained within 180 days
�� Date: (�
� � � r) after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:Building Permits PLMU-PermitApp.doc 10 01 09 440-46I6T(10 02 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suss ression S stems:
Footing drain-i"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 r 44:.z ,
+1rte _ Pr
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 ffi
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
t i �a 'tom �►a each additional$100.00 or fraction thereof,to
r • ° f ,• � `t i•� r) -- and including$10,000.00.
inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge i/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Pl itia teVje 'for Pltun_sog ns atiOAS ; •
Quanti y by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -23"'.
Isomeicor r Migrant
4
LI Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Corn/Scrv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:ABuilding\Permits\PLMF_PennitApp.doc 08/04/2011 2